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Health Care Insights - From Policy to Practice is the trusted source for news and commentary from the nation’s leading Health Care Eventsto inform Health Plans and Pharmaceutical Manufacturers on the latest developments on Medicare, Medicaid Managed Care, Government Programs, Medicaid Drug Rebate Program, and Health Insurance Exchanges. Topics we cover include reform, best business practices, the latest innovations, and novel payment models.

Contact Us: Would you like to guest blog on our site? Or send us feedback? Send an email to rgeswell@iirusa.com.

Thursday, October 29, 2009

The New York Times recently took a look at the bill Nancy Pelosi and the House. Their package includes a $894 billion package that will not add to the national debt. It will cover an additional 36 million by expanding Medicaid. The House had previously worked on three bills this summer, and this is a combination. Now it is up to Senator Harry Reid to combine the bills set out by the two parties. Read more here.

Tuesday, October 27, 2009

This article in The Wall Street Journal blog discusses how Republicans are taking aim at AARP by saying that they want an overhaul because its business arm would benefit from legislation in both the House and the Senate. Republicans mentioned in a recent hearing that support for the proposed cuts would lead to benefit cuts for seniors.

AARP membership has both fallen and risen in the past year so it is hard to see if more people are being turned away or drawn to it over this period.

Monday, October 26, 2009

According to Salon.com, the Harry Reid announced today that the Senate's bill for healthcare reform includes the option for states to opt out of public insurance. Many believe this is one of the keys for the healthcare reform to survive the legislative process. The House still has to introduce their bill, is still weighing their options, which includes one that pays doctors and hospitals on a fee schedule based on Medicare rates, or one that negotiates directly to set its own prices, much like private insurers do. Read more about the current healthcare reform situation here.

Wednesday, October 21, 2009

The Chicago Tribune reports there's growing agreement among policy experts about how Medicare will be affected.

The 10.4 million beneficiaries with private insurers' Medicare Advantage plans will still get coverage at least comparable to regular Medicare, but some will see fewer extra benefits or higher out-of-pocket costs.

For most of Medicare's 45 million beneficiaries, an overhaul will improve coverage by beefing up drug benefits, preserving access to physicians, paying for more preventive care and putting Medicare on firmer financial footing.

For more information about the Medicare policies, please visit the original article here.

Monday, October 19, 2009

Greg Burns of the Chicago Tribune writes that in a troubled economy, cheating Medicare and Medicaid just might be the easiest money anywhere. Recent reports about violent criminals and organized-crime figures putting aside their drug-running enterprises to pose as health care providers only scratch the surface.

Burns continues, some health care fraud is sophisticated and subtle. Some results in bloody crime scenes as hardened criminals enter the racket.

"If you're going to defraud somebody, the government is a reliable payer," said John Blum, a law professor at Loyola University Chicago who specializes in health matters. "Eventually, people like me catch up to you."

Read more about Burns' thoughts on Medicaid and Medicare fraud on his original post here.

Friday, October 16, 2009

All eyes on a possible second Republican senator who may cast her vote in support of President Obama's healthcare plan. Susan Collins joined fellow moderate Republican senator Olympia Snowe, in endorsing the goal of far-reaching changes in the US health care system. Collins said, "My hope is that we can fix the flaws in the bill and come together with a truly bipartisan bill that could garner widespread support."

The bill will be melded with a Senate Health Committee version before being debated in the full 100-member Senate, where Democrats will need all of their 60 votes to prevent a Republican filibuster.

About the web seminar:
All pharmaceutical product manufacturers who sell to various agencies of the federal government and/or who participate in Medicaid, 340B, Medicare or other public sector reimbursement programs face significant requirements and challenges with respect to their government-mandated pricing calculations and compliance reporting processes. Huge penalties and fines can be levied for miscalculating or incorrectly applying the various government price types to government-contracted sales and/or for compliance reporting mistakes.

The Seminar will address the complexities and challenges associated with automating Government Pricing and Medicaid Rebate system(s) as well as the pros and cons of using a packaged-software approach versus a custom-development approach. An overview of a leading-edge enterprise solution, developed as a fully-integrated component of the SAP® Enterprise Resource Planning (ERP) System, will be presented, accompanied by a live software demonstration and followed by a Question & Answer discussion of the issues.

What you will learn:
• An appreciation of the historical and legal background and context for the government-mandated price calculations and compliance reporting requirements;
• An understanding of the various price types that must be calculated, used in sales transaction processing and reported under each corresponding government program;
• Why automating and managing these processes using a packaged solution, based upon a fully-integrated enterprise architecture, is the lowest risk and lowest Total Cost of Ownership (TCO) approach;

Prior to founding Vistex, Mr. Shah spent several years as a Platinum Consultant in SAP America’s Professional Services Organization and in SAP AG’s Product Development Organization. That experience provided him with a comprehensive and unique understanding of the functionality gaps in SAP’s “core” offering as well as SAP’s product development strategy. Mr. Shah also worked in finance/accounting management at a major global manufacturing company.

Wednesday, October 14, 2009

Obama recently stated in his weekly video address that we are seeing "unprecedented consensus" from doctors, nurses, hospitals, and drug manufactures that healthcare reform is no longer a Democrat issue or Republican issue but an American issue that requires an immediate solution. In the address he mentions several new politicians who have his support for the new healthcare reform like Mayor Michael Bloomberg and California State Governor Arnold Schwarzenegger. Take at the video below provided by the Associated Press. What's your take on it?

Tuesday, October 13, 2009

Today is the day that the Senate Financial Committee is expected to vote and pass on bill that will overhaul the current American health care system. After the Senate Financial Committee has passed the bill, then it will be in the hands of the Senate Majority Leader Harry Reid to combine the bill passed by the Senate Financial Committee and the bill already approved by the Senate Committee on Health, Education, Labor and Pensions.

If the revised bill then picks up 60 Democratic votes in the Senate, Reid needs 60 votes to overcome a possible Republican filibuster. Read more about the vote here. Follow the vote via Live Blogging at the New York Times.

Thursday, October 8, 2009

This post in the LA Times highlights a healthcare quality rank conducted by the Commonwealth Fund. The results of the new ranking shows that these states are doing a decent job in terms of the cost of healthcare, quality of healthcare, access to healthcare and overall outcomes related to healthcare: Vermont, Hawaii, Iowa, Minnesota, Maine and New Hampshire. California which ranked 40th a couple years back now moved up to 31, quite a move. Take a look at the ranks here and let us know if anything surprises you.

Wednesday, October 7, 2009

According to Fox News, the Senate Finance Committee is waiting on a cost projection from Congressional Budget Office for the official numbers on how much the current health care package awaiting vote in the Senate would cost. Tax experts believe the bill will cost $121 billion over the next few years, which is $29 billion more than originally thought. Read the full article here.

Monday, October 5, 2009

This post on NBC New York discusses how President Obama made his healthcare pitch today in front of doctors and nurses that he believes understands firsthand the need for a major overhaul of the current healthcare system.

Friday, October 2, 2009

Join us at the start of the New Year for the health plan industry’s first congress of 2010. From operations and revenue drivers to marketing and competitive benchmarks, the 7th Annual Medicare Advantage Congress is your blueprint for optimizing the performance of your health plan. It’s a golden opportunity to interact with your colleagues, get insight into what your competitors are doing, and walk away with executable strategies for protecting profitability and driving growth.

This year’s program includes provocative Keynote Sessions delivered by the industry’s finest leaders:

Come together at The Medicare Congress to share the tools needed to improve quality, maximize revenue, ensure compliance, and improve operational efficiency in order to attract and retain members, protect and grow your organization’s Medicare market share, and improve clinical outcomes. With all the uncertainties coming our way, now is the time to prepare for what the future holds.

Thursday, October 1, 2009

The Kaiser Family Foundation reports that the number of people on Medicaid and state spending on the program are climbing sharply as a result of the recession, straining state budgets and pressuring officials to curb costs despite increased financial help from the federal government, according to a survey released today by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured.

The annual 50-state survey of state Medicaid officials finds that these trends are expected to continue well into the 2010 fiscal year, with the slumping economy contributing to the loss of jobs, private health coverage and state tax revenue at a time when more people are seeking help from public programs.

Across the country, states estimate Medicaid enrollment grew by an average of 5.4 percent in state fiscal 2009, the highest rate in six years, surpassing the projected 3.6 percent increase at the start of the year. Similarly, total Medicaid spending growth averaged 7.9 percent in FY 2009, the highest rate in five years, well above the 5.8 percent projected growth. For FY 2010, states estimate Medicaid enrollment will grow by 6.6 percent over FY 2009 levels.

The survey finds that, based on initial legislative appropriations, Medicaid spending across states is expected to grow by an average of at least 6.3 percent in fiscal 2010. But officials in three-fourths of the states are concerned that those appropriations will not be enough, leading to more budget shortfalls and more pressures to trim services and spending.

“The recession has shown the importance of Medicaid as a safety net for millions of Americans who have lost health coverage when they have lost their jobs,” said Diane Rowland, executive vice president of the Kaiser Family Foundation and executive director of the Kaiser Commission on Medicaid and the Uninsured. “But it also has shown the challenges for states of maintaining coverage when state revenues drop during times of economic crisis.”

American Recovery and Reinvestment Act (ARRA) Provides Some Fiscal Relief

The fiscal picture would have been much worse if not for the availability of increased federal Medicaid funding through the American Recovery and Reinvestment Act (ARRA).

The federal money, which will provide an estimated $87 billion to states through enhanced federal matching funds through December 31, 2010, helped all states, many of which are facing significant state budget shortfalls. States used the funds to address overall budget and Medicaid budget shortfalls, avoid cuts to providers, benefits and eligibility and address the recession-driven growth in enrollment.

ARRA also helped protect Medicaid eligibility. In order to qualify for the money, states had to ensure that their Medicaid eligibility standards, methodologies and procedures were no more restrictive than they had been on July 1, 2008, seven months before the enactment of the stimulus law. That requirement prompted 14 states to reverse new eligibility restrictions and five states to abandon planned new restrictions.

Nearly Every State Implemented Measures To Control Medicaid Spending

Even with federal relief, nearly every state implemented at least one new Medicaid policy to control spending in fiscal 2009 and 2010, the survey finds.

More than any other policy area, provider payment rate changes serve as a barometer of state fiscal conditions. Thirty-three states cut or froze provider rates in fiscal 2009, well above the 22 that had been expected to do so. Even more states (39) are slated to cut or freeze rates for FY 2010. And several others are considering it.

Rate cuts can jeopardize provider participation and inhibit Medicaid enrollees’ access to needed care. They bite particularly hard because some states have not fully restored provider rates to levels seen before the round of cuts in the last economic downturn from 2001 to 2004.

Several states also cut covered benefits or imposed new utilization controls for existing benefits, most commonly targeting dental and vision services for adults. Ten states reported benefits restrictions for fiscal 2009 and 15 reported them for fiscal 2010. California, Michigan and Utah instituted multiple benefit cuts.

Pressures Illustrate Challenges And Opportunities For Medicaid As A Cornerstone Of Health Reform

The reliance on Medicaid during times of economic crisis, and the fiscal pressures that follow, spotlight both the challenges and opportunities for the program in health reform efforts. Several legislative proposals in Congress include measures that would expand Medicaid to cover more low-income people as a platform for larger reform.

Because many states have already used Medicaid as a vehicle to expand health coverage, Medicaid officials expressed general support for an expanded role for the program in health reform. Even in these tight fiscal times over half of the states in FY 2009 and FY 2010 are moving forward with efforts to improve eligibility standards or the streamline application processes in a bid to cover more people. Among the states implementing the broadest reforms and eligibility expansions are Colorado, Maryland, New York, Oklahoma and Wisconsin.
However, state Medicaid officials did register concerns about health reform, too, reflecting current state budget situations. Three-quarters of states expressed concern that Medicaid eligibility expansions, mandated minimum provider rates and new administrative costs – depending on how they were financed -- could add to state fiscal woes.